| NPI | 1124379995 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39093) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000002122) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2018-03-23 |